Current Concepts Review   |    
Psychosocial Aspects of Disabling Musculoskeletal Pain
Ana-Maria Vranceanu, PhD1; Arthur Barsky, MD2; David Ring, MD, PhD1
1 Orthopaedic Hand and Upper Extremity Services, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
2 Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
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Disclosure: In support of their research in the past year, one or more of the authors received outside funding or grants (unrestricted, without clear designation) from Small Bone Innovations, Acumed, Tornier, Smith and Nephew, and Wright Medical (in excess of $10,000 in total). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):2014-2018. doi: 10.2106/JBJS.H.01512
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Psychosocial factors are important determinants of pain intensity and disability in patients with disabling musculoskeletal pain.

The psychosocial aspects of disabling musculoskeletal pain include cognitive (e.g., beliefs, expectations, and coping style), affective (e.g., depression, pain anxiety, heightened concern about illness, and anger), behavioral (e.g., avoidance), social (e.g., secondary gain), and cultural factors.

The effectiveness of cognitive behavioral therapy and other treatments that address the psychosocial aspects of disabling musculoskeletal pain has been confirmed in numerous high-quality studies.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Dorothea Z. Lack, PhD
    Posted on September 01, 2010
    I Have A Dream
    Independent Practice, San Francisco, CA

    To the Editor:

    I was pleased to read the fine article, "Psychosocial Aspects of Disabling Musculoskeletal Pain" (2009;91:2014-8), by Vranceanu et al. I very much agree with their conclusions, and they are similar to findings stated in my own article (1).

    The evidence is now significant and growing, that psychological issues play a large role in the outcome of various orthopaedic procedures and in the progress of patients with chronic musculoskeletal pain.

    Nurses have always played a significant role in the treatment of orthopaedic patients, as evidenced by the National Association of Orthopaedic Nurses. I would like to suggest that a similar association, The National Association of Orthopaedic Psychologists be added to the American Academy of Orthopaedic Surgeons (AAOS). Such a group would provide access to the most up-to-date information for Psychologists who have chosen this path. In order to be effective with orthopaedic patients, it is necessary to understand the science and treatment of patients with musculoskeletal disorders.

    In my opinion, the inclusion of psychology would be an asset to the AAOS.

    The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.


    1. Lack DZ, Ries MD, Sack S, Fong C. Psychological aspects of total joint arthroplasty. Independ Practitioner. 2010;30:63-6.

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